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1.
Psychiatr Prax ; 47(1): 22-28, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31910457

RESUMO

INTRODUCTION: Over the last decade, methamphetamine use has spread rapidly in Europe, leading to a significant medical shortfall in many regions. To date, there are no standardized German-language therapy programs for qualified detoxification and motivation treatment. We have developed a therapy manual ("CrystalClean") over 15 therapy modules, which was evaluated in the present pilot study with regard to feasibility and acceptability. METHODS: Observational study with systematic interviews over 3 months on 31 patients with methamphetamine dependence. RESULTS: Acceptability of most modules was rated as high by both patients and therapists. In addition, the manual was considered to be well feasible in inpatient daily routine. However, contact terminations frequently occurred when switching to outpatient treatment. CONCLUSION: Results from our study point to a high acceptance of the manual for the accompaniment of qualified detoxification and motivation treatment in patients with methamphetamine dependence. Feasibility in the clinical setting can be improved by reducing the number of modules to the 12 best evaluated and by increasing the frequency of therapies.


Assuntos
Linguagem , Metanfetamina , Transtornos Relacionados ao Uso de Opioides/reabilitação , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Europa (Continente) , Estudos de Viabilidade , Alemanha , Humanos , Motivação , Aceitação pelo Paciente de Cuidados de Saúde , Projetos Piloto , Tradução
2.
J Forensic Sci ; 65(1): 97-102, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31386191

RESUMO

Understanding trends in substance use by gender among jail-based treatment program participants can inform policies and programs tailored to this population. Preprogram assessment data from 3509 individuals entering a jail-based substance use disorder treatment program in Missouri between 1998 and 2016 were analyzed. Primary outcome was program participants' strongly preferred substances. Demographic covariates and drug preferences were compared between males and females. Average yearly trends in preferred substances were calculated. While 25.8% of the sample preferred heroin, it was more strongly preferred by women (36.4%) than men (22.0%, p < 0.0001). Alcohol and marijuana were preferred more by males. Overall, preferences for heroin and methamphetamine increased over time while alcohol, marijuana, and other stimulants decreased. Women being more likely to prefer heroin and the increasing preference for heroin over time are consistent with national trends. Offering evidence-based treatment like pharmacotherapy and gender-sensitive approaches can help address the needs of this vulnerable population.


Assuntos
Comportamento de Escolha , Prisioneiros , Fatores Sexuais , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Distribuição por Idade , Consumo de Bebidas Alcoólicas , Cannabis , Cocaína , Cocaína Crack , Feminino , Heroína , Humanos , Masculino , Metanfetamina , Missouri/epidemiologia , Medicamentos sob Prescrição , Distribuição por Sexo , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adulto Jovem
3.
J Ment Health Policy Econ ; 22(3): 109-120, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31811754

RESUMO

BACKGROUND: Recovery high schools (RHS) provide a supportive educational and therapeutic environment for students subsequent to treatment for substance use disorders (SUDs). Most students served by RHSs have concurrent mental health disorders and are at risk for school failure or dropout and substance use relapse. AIMS OF THE STUDY: The central question addressed is whether RHSs are economically efficient alternatives to other high school settings for students in recovery. The aim is to estimate the incremental cost-benefit of RHSs. METHODS: A quasi-experimental non-equivalent pretest-posttest comparison group design was used. We compared substance use and educational outcomes for adolescents who had received specialty SUD treatment; 143 who enrolled in an RHS were compared to 117 who enrolled in a non-RHS school. Groups were balanced by use of a propensity score to drop students who were not similar to those in the other group. The propensity score was also used as a covariate in multiple regression to estimate cost and outcome parameters and standard errors. To take account of uncertainties in impacts and shadow prices, we used Monte Carlo simulations to estimate the distribution of incremental benefits of RHS relative to non-RHS schooling. RESULTS: Two beneficial impacts of statistical and substantive importance were identified: increased probability of high school graduation and increased sobriety. RHS students had significantly (p<.05) less substance use during the study period -- at 12-month follow-up, 55% of RHS and 26% of comparison students reported 3 month abstinence from alcohol and drugs. Urinalysis confirmed abstinence from THC (cannabis) for 68% of RHS versus 37% of comparison students. RHS students' high school graduation rates were 21 to 25 percentage points higher than comparison students. Adopting a societal perspective, incremental benefits of RHSs were estimated by monetizing the increased probability of high school graduation and comparing it to incremental costs. Mean net benefits ranged from USD16.1 thousand to USD51.9 thousand per participant; benefit-to-cost ratios ranged from 3.0 to 7.2. DISCUSSION: Monetizing the benefits and the incremental costs of RHS relative to conventional schooling show substantial positive net benefits from RHS participation. Two factors lend credibility to the results. First, the RHS improvement in substance use indicates a mechanism through which the increased probability of high school graduation can plausibly occur. Second, the estimated increases in the probability of high school graduation were large and statistically significant. As the productivity gains from high school graduation are also large, the dominant benefit category is very plausible. Limitations include the non-randomized design; selection bias into the study conditions not fully controlled by the propensity scores; generalizability only to young people with treated behavioral health disorders; lack of estimates for direct monetization of reduced substance use among adolescents; possible attenuation of the value of education among individuals with behavioral health issues; and uncertainty in calculation of school costs. IMPLICATIONS FOR BEHAVIORAL HEALTH POLICIES: This research provides evidence that the recovery high school model provides cost beneficial support for high school students after primary SUD treatment. The students who enroll in RHSs typically have co-occurring mental health and substance use disorders, adding complexity to their continuing care. Funding policies recognizing the multiple systems of care (behavioral health, education, child and family services, juvenile justice) responsible for these young people are called for.


Assuntos
Sucesso Acadêmico , Serviços de Saúde Escolar/economia , Serviços de Saúde Escolar/estatística & dados numéricos , Estudantes/psicologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Adolescente , Comportamento do Adolescente/psicologia , Criança , Doença Crônica , Análise Custo-Benefício , Humanos , Estudos Longitudinais , Estudos Prospectivos , Instituições Acadêmicas , Estudantes/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/reabilitação
4.
Psychol Addict Behav ; 33(8): 669-676, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31724415

RESUMO

Recovery high schools (RHSs) provide a recovery-supportive academic environment for adolescents in recovery from a substance use disorder and are located across the United States. However, only a small proportion of the 160,000 youth in recovery each year in the United States enroll in RHSs posttreatment, indicating that many youth do not access this relapse prevention resource despite its effectiveness. Thus, this study uses the adolescent-adapted recovery capital model (RCAM) to understand individual- and community-level predictors of attendance and identify disparities leading to barriers to accessing RHSs. Data were collected as part of a multisite observational study of adolescents in recovery (N = 294). Logistic regressions and classification trees explored which different recovery capital factors predicted the odds of attending an RHS for at least 28 days during a 12-month period (n = 171) versus a non-RHS (e.g., traditional school: n = 123). The RCAM model is a useful theoretical framework for examining predictors of RHS attendance, and both analysis methods identified multiple unique predictors of RHS attendance. The strongest predictors of RHS attendance were individual-level factors, including problem-solving skills, 12-Step frequency, and financial resources. The classification trees highlighted additional interactions that should be explored in future empirical research. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Instituições Acadêmicas , Estudantes , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adolescente , Mineração de Dados , Feminino , Humanos , Masculino
5.
J Forensic Nurs ; 15(4): 231-241, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31764527

RESUMO

INTRODUCTION: Clients on methadone maintenance treatment (MMT) have high attrition rates that are attributed to personal and system-related factors. To develop supportive interventions for these clients, it is imperative to understand social demographic characteristics and challenges that clients in the MMT program face. OBJECTIVES: This article aims to describe (a) the sociodemographic characteristics and clinical profiles of clients in a MMT program, (b) factors that impact their positive clinical outcomes, and (c) the study's implications for practice. METHODS: A retrospective review of 101 randomly selected electronic medical records representing one third of all the records were examined for sociodemographic characteristics, clinical profiles, and outcomes. Descriptive statistics were used to analyze these variables. Interviews with 18 healthcare providers focusing on their experiences of caring for clients in the MMT program were analyzed thematically. RESULTS: The average age of clients on MMT is 35.5 years. Clients had early exposure to alcohol and drugs, and at the time of enrollment to the program, they presented with complex healthcare needs, borne from chronic use, and exposure to adverse traumatic events. Personal and systemic factors impact clients' recovery. These include poverty, homelessness, and inadequate healthcare services. Understanding sociodemographic characteristics, clinical profiles, and clients' challenges is central to the development of supportive interventions that enhance retention to care and recovery.


Assuntos
Analgésicos Opioides/uso terapêutico , Metadona/uso terapêutico , Tratamento de Substituição de Opiáceos , Centros de Tratamento de Abuso de Substâncias , Adulto , Distribuição por Idade , Canadá/epidemiologia , Feminino , Necessidades e Demandas de Serviços de Saúde , Pessoas em Situação de Rua , Humanos , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Distribuição por Sexo , Meio Social , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adulto Jovem
6.
BMC Health Serv Res ; 19(1): 687, 2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31601199

RESUMO

BACKGROUND: Social inequities are widening globally, contributing to growing health and health care inequities. Health inequities are unjust differences in health and well-being between and within groups of people caused by socially structured, and thus avoidable, marginalizing conditions such as poverty and systemic racism. In Canada, such conditions disproportionately affect Indigenous persons, racialized newcomers, those with mental health and substance use issues, and those experiencing interpersonal violence. Despite calls to enhance equity in health care to contribute to improving population health, few studies examine how to achieve equity at the point of care, and the impacts of doing so. Many people facing marginalizing conditions experience inadequate and inequitable treatment in emergency departments (EDs), which makes people less likely to access care, paradoxically resulting in reliance on EDs through delays to care and repeat visits, interfering with effective care delivery and increasing human and financial costs. EDs are key settings with potential for mitigating the impacts of structural conditions and barriers to care linked to health inequities. METHODS: EQUIP is an organizational intervention to promote equity. Building on promising research in primary health care, we are adapting EQUIP to emergency departments, and testing its impact at three geographically and demographically diverse EDs in one Canadian province. A mixed methods multisite design will examine changes in key outcomes including: a) a longitudinal analysis of change over time based on structured assessments of patients and staff, b) an interrupted time series design of administrative data (i.e., staff sick leave, patients who leave without care being completed), c) a process evaluation to assess how the intervention was implemented and the contextual features of the environment and process that are influential for successful implementation, and d) a cost-benefit analysis. DISCUSSION: This project will generate both process- and outcome-based evidence to improve the provision of equity-oriented health care in emergency departments, particularly targeting groups known to be at greatest risk for experiencing the negative impacts of health and health care inequities. The main deliverable is a health equity-enhancing framework, including implementable, measurable interventions, tested, refined and relevant to diverse EDs. TRIAL REGISTRATION: Clinical Trials.gov # NCT03369678 (registration date November 18, 2017).


Assuntos
Assistência à Saúde/normas , Serviço Hospitalar de Emergência/normas , Equidade em Saúde/organização & administração , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Colúmbia Britânica , Protocolos Clínicos , Serviço Hospitalar de Emergência/organização & administração , Humanos , Índios Norte-Americanos/estatística & dados numéricos , Análise de Séries Temporais Interrompida , Serviços de Saúde Mental/normas , Serviços de Saúde Mental/estatística & dados numéricos , Atenção Primária à Saúde/organização & administração , Racismo/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Violência/estatística & dados numéricos
7.
Asia Pac J Public Health ; 31(6): 548-558, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31516020

RESUMO

This study was conducted to identify factors associated with the utilization of treatment and rehabilitation services by drug abusers. Around 14.7% of drug abusers self-reported as having used treatment and rehabilitation services at any point in their lifetime (90.8% male and 9.2% female). The dependent variable of having "ever used" the services was positively associated with receiving support of family and friends, knowing of an existing treatment and rehabilitation program, having ever been involved in an outreach program activity, experiencing self-treatment, and having a positive perception of the efficacy of the program. Among the 10 cities examined, the findings showed unequal utilization of treatment and rehabilitation services, implying the need to better monitor the use of the services and to develop a community-based treatment that both enables drug abusers to confront barriers to the utilization of treatment and rehabilitation services and also reintegrates drug abusers to the community.


Assuntos
Centros de Tratamento de Abuso de Substâncias/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adulto , Feminino , Humanos , Indonésia , Masculino , Inquéritos e Questionários , Adulto Jovem
9.
Physiol Rev ; 99(4): 2115-2140, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31507244

RESUMO

Drug consumption is driven by a drug's pharmacological effects, which are experienced as rewarding, and is influenced by genetic, developmental, and psychosocial factors that mediate drug accessibility, norms, and social support systems or lack thereof. The reinforcing effects of drugs mostly depend on dopamine signaling in the nucleus accumbens, and chronic drug exposure triggers glutamatergic-mediated neuroadaptations in dopamine striato-thalamo-cortical (predominantly in prefrontal cortical regions including orbitofrontal cortex and anterior cingulate cortex) and limbic pathways (amygdala and hippocampus) that, in vulnerable individuals, can result in addiction. In parallel, changes in the extended amygdala result in negative emotional states that perpetuate drug taking as an attempt to temporarily alleviate them. Counterintuitively, in the addicted person, the actual drug consumption is associated with an attenuated dopamine increase in brain reward regions, which might contribute to drug-taking behavior to compensate for the difference between the magnitude of the expected reward triggered by the conditioning to drug cues and the actual experience of it. Combined, these effects result in an enhanced motivation to "seek the drug" (energized by dopamine increases triggered by drug cues) and an impaired prefrontal top-down self-regulation that favors compulsive drug-taking against the backdrop of negative emotionality and an enhanced interoceptive awareness of "drug hunger." Treatment interventions intended to reverse these neuroadaptations show promise as therapeutic approaches for addiction.


Assuntos
Comportamento Aditivo , Encéfalo/fisiopatologia , Usuários de Drogas/psicologia , Recompensa , Transtornos Relacionados ao Uso de Substâncias/fisiopatologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Animais , Encéfalo/metabolismo , Neurônios Dopaminérgicos/metabolismo , Humanos , Vias Neurais/metabolismo , Vias Neurais/fisiopatologia , Plasticidade Neuronal , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/metabolismo , Transtornos Relacionados ao Uso de Substâncias/reabilitação
10.
J Addict Nurs ; 30(3): 169-176, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31478964

RESUMO

Globally, from America to Europe and beyond, the need for the expansion of the role of nurse practitioners has been recognized within the healthcare professions. However, little emphasis has been placed on assessing the views of clients, and within the addiction services, the voice of clients can be additionally marginalized as a result of treatment philosophies, stigma, and resource constraints. The aims of this study were to establish from clients their nursing needs and to use these findings alongside an objective measurement of clients' health, to inform the development of a nurse-led treatment model.A cross-sectional survey with open-ended questions on client nursing needs was conducted in 2017 within a representative sample of six clinics in Dublin, Ireland. A convenience sample of 131 clients were interviewed. Interviews were analyzed using thematic analysis.Findings were both as expected and surprising. Clients articulated the role of the nurse in their physical care; however, unexpectedly, clients identified nurses as an essential source of psychological support and expressed the wish for the role to be expanded in terms of managing methadone treatment and accessing additional services and resources.Results contributed to the formation of the nurse-led, client mental-health-focused, Healthy Addiction Treatment Recovery Model for addiction nursing services. In terms of national policies, findings provided new evidence articulated by service users on their desire for the expansion of nurse prescribing in addiction services and an expansion of the role to more adequately address client needs.


Assuntos
Relações Enfermeiro-Paciente , Padrões de Prática em Enfermagem , Transtornos Relacionados ao Uso de Substâncias/enfermagem , Adulto , Idoso , Analgésicos Opioides/uso terapêutico , Atitude Frente a Saúde , Comunicação , Estudos Transversais , Substituição de Medicamentos , Feminino , Humanos , Assistência de Longa Duração , Masculino , Metadona/uso terapêutico , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Profissionais de Enfermagem/psicologia , Papel do Profissional de Enfermagem , Defesa do Paciente , Apoio Social , Transtornos Relacionados ao Uso de Substâncias/reabilitação
11.
BMC Health Serv Res ; 19(1): 656, 2019 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-31500620

RESUMO

BACKGROUND: In Thailand, two community-based drug treatment approaches are common. The first one is the traditional community-based treatment program (FAST) which brings the principles of community therapy as a guideline for treatment. The second one is the military hospital-based drug treatment program (PMK), derived from the basic military training, the Buddhist Twelve Steps, CBT and the Minnesota Rehabilitation Model. This study aimed to investigate and compare the efficacy of PMK vs. FAST. METHOD: The experiment was conducted from January-March 2016 at the rehabilitation center for patients with drug addiction in Thailand. Quasi-experimental methods were introduced, and ASSIST, WHOQOL-BRIEF-THAI and self-efficacy interview form were applied. After completing the drug rehabilitation program at a total duration of 120 days, the researcher continued at follow up times at 3 and 6 months. RESULTS: Compared with baseline scores, both programs significantly reduced the severity of drugs and increased self-efficacy at 6-month follow-up. PMK had better improved scores in the relationship and environment dimensions of quality of life at 3-month follow-up (P = 0.026, 0.006). The mean quality of life scores in PMK at 3 and 6 months showed better results than mean scores at baseline (P = < 0.001). CONCLUSION: Both community-based programs in Thailand significantly reduced the severity of drugs and increased self-efficacy scores at 6-month follow-up. PMK and FAST has not shown any significant difference in treatment outcome results in the aspects of self-efficacy and reduced severity of drugs used. However, PMK had significant positive effects on the quality of life.


Assuntos
Qualidade de Vida , Autoeficácia , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adulto , Serviços Comunitários de Saúde Mental/estatística & dados numéricos , Hospitais Militares , Humanos , Masculino , Pessoa de Meia-Idade , Centros de Tratamento de Abuso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/psicologia , Tailândia , Resultado do Tratamento
12.
BMC Med ; 17(1): 161, 2019 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-31412884

RESUMO

BACKGROUND: Cannabis is the most commonly used illicit substance amongst people with psychosis. Continued cannabis use following the onset of psychosis is associated with poorer functional and clinical outcomes. However, finding effective ways of intervening has been very challenging. We examined the clinical and cost-effectiveness of adjunctive contingency management (CM), which involves incentives for abstinence from cannabis use, in people with a recent diagnosis of psychosis. METHODS: CIRCLE was a pragmatic multi-centre randomised controlled trial. Participants were recruited via Early Intervention in Psychosis (EIP) services across the Midlands and South East of England. They had had at least one episode of clinically diagnosed psychosis (affective or non-affective); were aged 18 to 36; reported cannabis use in at least 12 out of the previous 24 weeks; and were not currently receiving treatment for cannabis misuse, or subject to a legal requirement for cannabis testing. Participants were randomised via a secure web-based service 1:1 to either an experimental arm, involving 12 weeks of CM plus a six-session psychoeducation package, or a control arm receiving the psychoeducation package only. The total potential voucher reward in the CM intervention was £240. The primary outcome was time to acute psychiatric care, operationalised as admission to an acute mental health service (including community alternatives to admission). Primary outcome data were collected from patient records at 18 months post-consent by assessors masked to allocation. The trial was registered with the ISRCTN registry, number ISRCTN33576045. RESULTS: Five hundred fifty-one participants were recruited between June 2012 and April 2016. Primary outcome data were obtained for 272 (98%) in the CM (experimental) group and 259 (95%) in the control group. There was no statistically significant difference in time to acute psychiatric care (the primary outcome) (HR 1.03, 95% CI 0.76, 1.40) between groups. By 18 months, 90 (33%) of participants in the CM group, and 85 (30%) of the control groups had been admitted at least once to an acute psychiatric service. Amongst those who had experienced an acute psychiatric admission, the median time to admission was 196 days (IQR 82, 364) in the CM group and 245 days (IQR 99, 382) in the control group. Cost-effectiveness analyses suggest that there is an 81% likelihood that the intervention was cost-effective, mainly resulting from higher mean inpatient costs for the control group compared with the CM group; however, the cost difference between groups was not statistically significant. There were 58 adverse events, 27 in the CM group and 31 in the control group. CONCLUSIONS: Overall, these results suggest that CM is not an effective intervention for improving the time to acute psychiatric admission or reducing cannabis use in psychosis, at least at the level of voucher reward offered.


Assuntos
Terapia Comportamental/métodos , Cannabis , Transtornos Psicóticos/terapia , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adolescente , Adulto , Terapia Comportamental/economia , Cannabis/efeitos adversos , Condicionamento Operante , Análise Custo-Benefício , Inglaterra , Feminino , Humanos , Masculino , Motivação , Adulto Jovem
13.
Psychiatr Rehabil J ; 42(3): 207-209, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31464483

RESUMO

This special issue on psychiatric rehabilitation for veterans celebrates the Department of Veterans Affairs' commitment to innovation in psychiatric rehabilitation and recovery through service delivery and research. The scope of the articles also raises issues about the evolution of the field and how one defines psychiatric rehabilitation. Special issues such as this provide the opportunity to push at the boundaries and encourage the field to continue to advance how psychiatric rehabilitation efforts are defined, measured, evaluated, and put into practice across the care continuum. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Lesões Encefálicas Traumáticas/reabilitação , Reabilitação Psiquiátrica/tendências , Transtornos de Estresse Pós-Traumáticos/reabilitação , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Veteranos , Adulto , Humanos , Estados Unidos , United States Department of Veterans Affairs
15.
Artigo em Inglês | MEDLINE | ID: mdl-31261620

RESUMO

Meeting adherence is an important element of compliance in treatment programmes. It is influenced by several factors one being self-efficacy. We aimed to investigate the association between self-efficacy and meeting adherence and other factors of importance for adherence among patients with alcohol and drug addiction who were undergoing an intensive lifestyle intervention. The intervention consisted of a 6-week Very Integrated Programme. High meeting adherence was defined as >75% participation. The association between self-efficacy and meeting adherence were analysed. The qualitative analyses identified themes important for the patients and were performed as text condensation. High self-efficacy was associated with high meeting adherence (ρ = 0.24, p = 0.03). In the multivariate analyses two variables were significant: avoid complications (OR: 0.51, 95% CI: 0.29-0.90) and self-efficacy (OR: 1.28, 95% CI: 1.00-1.63). Reflections on lifestyle change resulted in the themes of Health and Wellbeing, Personal Economy, Acceptance of Change, and Emotions Related to Lifestyle Change. A higher level of self-efficacy was positively associated with meeting adherence. Patients score high on avoiding complications but then adherence to the intervention drops. There was no difference in the reflections on lifestyle change between the group with high adherence and the group with low adherence.


Assuntos
Alcoolismo/reabilitação , Exercício , Cooperação do Paciente , Abandono do Hábito de Fumar/métodos , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Comorbidade , Feminino , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Autoeficácia , Mensagem de Texto
16.
BMJ Case Rep ; 12(7)2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31352378

RESUMO

A 45-year-old man, a regular cocaine user, presented with confusion and unusual behaviour to the emergency room. On examination he was unable to perform simple tasks or follow commands. He was treated for possible central nervous system infection. MRI of the brain showed multiple bilateral T2 hyperintense periventricular and deep white matter foci, best appreciated on FLAIR with contrast enhancement. He continued deteriorating, eventually becoming catatonic with extensor posturing and increased tone, requiring intensive therapy unit management. Repeat MRIs were also noted to show worsening changes. He was treated for a presumed inflammatory leucoencephalopathy with intravenous methylprednisolone, immunoglobulins, as well as plasmapheresis. After 2 weeks, the patient started to show clinical improvement with eventual transfer to a rehabilitation hospital. A year after his first presentation, the patient scored 30 out of 30 on the MMSE and his neurological examination was normal.


Assuntos
Cocaína/efeitos adversos , Confusão/induzido quimicamente , Leucoencefalopatias/fisiopatologia , Transtornos Mentais/induzido quimicamente , Transtornos Relacionados ao Uso de Substâncias/fisiopatologia , Substância Branca/patologia , Confusão/fisiopatologia , Eletroencefalografia , Humanos , Imunoglobulinas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Leucoencefalopatias/induzido quimicamente , Leucoencefalopatias/terapia , Imagem por Ressonância Magnética , Masculino , Transtornos Mentais/fisiopatologia , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Plasmaferese , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Transtornos Relacionados ao Uso de Substâncias/terapia , Resultado do Tratamento
18.
Early Interv Psychiatry ; 13 Suppl 1: 20-28, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31243907

RESUMO

AIM: In many parts of the world, there is growing concern about youth homelessness. Homeless youth are particularly vulnerable to psychological distress, substance use and mental disorders, and premature mortality caused by suicide and drug overdose. However, their access to and use of mental health care is very limited. METHODS: The Réseau d'intervention de proximité auprès des jeunes (RIPAJ), a Montreal network of over 20 community stakeholders providing a wide array of cohesive services, was created to ease homeless youth's access to mental health and psychosocial services. Its philosophy is that there should be no "wrong door" or "wrong timing" for youth seeking help. In 2014, the network partnered with the pan-Canadian transformational research initiative, ACCESS Esprits ouverts. RESULTS: Created through this partnership, ACCESS Esprits ouverts RIPAJ has been promoting early identification through outreach activities targeting homeless youth and agencies that serve them. An ACCESS Clinician was hired to promote and rapidly respond to help-seeking and referrals. By strengthening connections within RIPAJ and using system navigation, the site is working to facilitate youth's access to timely appropriate care and eliminate age-based transitions between services. A notable feature of our program, that is not usually evident in homelessness services, has been the engagement of the youth in service planning and design and the encouragement of contact with families and/or friends. CONCLUSION: Challenges remain including eliminating any remaining age-related transitions of care between adolescent and adult services; and the sustainability of services transformation and network coordination. Nonetheless, this program serves as an example of an innovative, much-needed, community-oriented model for improving access to mental health care for homeless youth.


Assuntos
Acesso aos Serviços de Saúde/organização & administração , Jovens em Situação de Rua/psicologia , Comunicação Interdisciplinar , Colaboração Intersetorial , Serviços de Saúde Mental/organização & administração , Melhoria de Qualidade/organização & administração , Serviços Urbanos de Saúde/organização & administração , Adolescente , Criança , Feminino , Pesquisa sobre Serviços de Saúde/organização & administração , Humanos , Masculino , Transtornos Mentais/psicologia , Transtornos Mentais/reabilitação , Equipe de Assistência ao Paciente/organização & administração , Quebeque , Transtornos Relacionados ao Uso de Substâncias/psicologia , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adulto Jovem
19.
Early Interv Psychiatry ; 13 Suppl 1: 14-19, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31243911

RESUMO

AIM: This paper outlines the transformation of youth mental health services in Edmonton, Alberta, a large city in Western Canada. We describe the processes and challenges involved in restructuring how services and care are delivered to youth (11-25 years old) with mental health needs based on the objectives of the pan-Canadian ACCESS Open Minds network. METHODS: We provide a narrative review of how youth mental health services have developed since our engagement with the ACCESS Open Minds initiative, based on its five central objectives of early identification, rapid access, appropriate care, continuity of care, and youth and family engagement. RESULTS: Building on an initial community mapping exercise, a service network has been developed; teams that were previously age-oriented have been integrated together to seamlessly cover the age 11 to 25 range; early identification has thus far focused on high-school populations; and an actual drop-in space facilitates rapid access and linkages to appropriate care within the 30-day benchmark. CONCLUSIONS: Initial aspects of the transformation have relied on restructuring and partnerships that have generated early successes. However, further transformation over the longer term will depend on data demonstrating how this has impacted clinical outcomes and service utilization. Ultimately, sustainability in a large urban centre will likely involve scaling up to a network of similar services to cover the entire population of the city.


Assuntos
Serviços de Saúde do Adolescente/organização & administração , Acesso aos Serviços de Saúde/organização & administração , Transtornos Mentais/reabilitação , Serviços de Saúde Mental/organização & administração , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Serviços Urbanos de Saúde/organização & administração , Adolescente , Adulto , Alberta , Criança , Assistência à Saúde , Feminino , Humanos , Masculino , Equipe de Assistência ao Paciente/organização & administração , Encaminhamento e Consulta/organização & administração , Adulto Jovem
20.
Expert Opin Drug Saf ; 18(8): 753-758, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31177863

RESUMO

Objectives: Z-Drugs (ZDs) have been developed to limit benzodiazepines (BZDs) abuse for sleep disorders. Data on the liver toxicity of zolpidem (ZLM) are lacking or anecdotal. The authors evaluated the presence of drug-induced liver injury (DILI) among a cohort of high-dose ZLM abusers. Methods: Retrospective study analyzing clinical records of 1112 consecutive patients admitted for BZDs detoxification from 2003 to 2018. Inclusion criteria: age >18 y.o.; ZLM abuse/dependence; high-dose ZDs abuse. Exclusion criteria: missing lab data; lack of informed consent. Main outcome was the presence of DILI measured as elevation of ALT/AST levels >250 U/l. Results: A total of 107 patients met the eligibility criteria. Liver enzymes alterations were present in 9.3% (95% CI 4.6-16.5%); one patient (0.9%, 95% CI 0.0-2.8%) showed DILI criteria. BMI significantly influenced transaminases levels. No correlations between duration nor doses of ZLM abuse and transaminases levels were found. Conclusion: The present study shows a very low prevalence of DILI among high-dose ZLM abusers. The prevalence of hypertransaminasemia was in line with general population. On one hand ZLM has a substantially safe liver profile but on the other hand ZLM abuse and dependence, especially at very high doses, represents an emerging problem.


Assuntos
Doença Hepática Induzida por Substâncias e Drogas/epidemiologia , Medicamentos Indutores do Sono/administração & dosagem , Transtornos Relacionados ao Uso de Substâncias/complicações , Zolpidem/administração & dosagem , Adulto , Alanina Transaminase/metabolismo , Aspartato Aminotransferases/metabolismo , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Relação Dose-Resposta a Droga , Feminino , Humanos , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Medicamentos Indutores do Sono/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Zolpidem/efeitos adversos
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